Discusses causes and symptoms of COPD. Looks at chronic bronchitis and emphysema, two diseases that are usually a part of COPD. Covers quitting smoking. Includes treatment with bronchodilators and inhaled corticosteroids. Offers home treatment tips.

COPD (Chronic Obstructive Pulmonary Disease)

Topic Overview

What is chronic obstructive pulmonary disease (COPD)?

COPD is a lung disease that makes it hard to breathe. It is caused by
damage to the lungs over many years, usually from smoking.

COPD
is often a mix of two diseases:

Chronic bronchitis (say "bron-KY-tus").
In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes) get inflamed and make a lot of
mucus. This can narrow or block the airways, making it
hard for you to breathe.

Emphysema (say "em-fuh-ZEE-muh"). In a
healthy person, the tiny air sacs in the lungs are like balloons. As you
breathe in and out, they get bigger and smaller to move air through your lungs.
But with emphysema, these air sacs are damaged and lose their stretch. Less air
gets in and out of the lungs, which makes you feel short of breath.

COPD gets worse over time. You can't undo the damage to
your lungs. But you can take steps to prevent more damage and to feel
better.

What causes COPD?

COPD is almost always caused by
smoking. Over time, breathing tobacco smoke irritates the airways and destroys
the stretchy fibers in the lungs.

Other things that may put you
at risk include breathing chemical fumes, dust, or air pollution over a long
period of time. Secondhand smoke also may damage the lungs.

It usually takes
many years for the lung damage to start causing symptoms, so COPD is most
common in people who are older than 60.

You may be more likely to
get COPD if you had a lot of serious lung infections when you were a child.
People who get emphysema in their 30s or 40s may have a disorder that runs in
families, called alpha-1 antitrypsin deficiency. But this is rare.

What are the symptoms?

The main symptoms
are:

A long-lasting (chronic) cough.

Mucus that comes up when you cough.

Shortness of breath that gets worse when you exercise.

As COPD gets worse, you may be short of breath even when
you do simple things like get dressed or fix a meal. It gets harder to eat or
exercise, and breathing takes much more energy. People often lose weight and
get weaker.

At times, your symptoms may suddenly flare up and get
much worse. This is called a COPD exacerbation (say "egg-ZASS-er-BAY-shun"). An
exacerbation can range from mild to life-threatening. The longer you have COPD,
the more severe these flare-ups will be.

How is COPD diagnosed?

To find out if you have
COPD, a doctor will:

Do a physical exam and listen to your lungs.

Ask you questions about your past health and whether you smoke
or have been exposed to other things that can irritate your lungs.

Have you do breathing tests, including
spirometry, to find out how well your lungs work.

Do chest
X-rays and other tests to help rule out other problems
that could be causing your symptoms.

If there is a chance you could have COPD, it is very
important to find out as soon as you can. This gives you time to take steps to
slow the damage to your lungs.

How is it treated?

The best way to slow COPD is to
quit smoking. This is the most important thing you can do. It is never too late
to quit. No matter how long you have smoked or how serious your COPD is,
quitting smoking can help stop the damage to your lungs.

Your doctor can prescribe
treatments that may help you manage your symptoms and feel better.

Medicines can help you breathe easier. Most of them are inhaled
so they go straight to your lungs. If you get an inhaler, it is very important
to use it just the way your health provider shows you.

A lung (pulmonary) rehab program can help you learn to manage
your disease. A team of health professionals can provide counseling and teach
you how to breathe easier, exercise, and eat well.

In time, you may need to use
oxygen some or most of the time.

People who have COPD are more likely to get lung
infections, so you will need to get a
flu vaccine every year. You should also get a
pneumococcal shot. It may not keep you from getting
pneumonia. But if you do get pneumonia, you probably won't be as
sick.

How can you live well with COPD?

There are many things you can do at home to stay as healthy
as you can.

Avoid things that can irritate your lungs, such as smoke and air
pollution.

Use an air filter in your home.

Get regular exercise to stay as strong as you can.

Eat well so you can keep up your strength. If you are losing
weight, ask your doctor or
dietitian about ways to make it easier to get the
calories you need.

Dealing with flare-ups: As COPD gets worse, you may have flare-ups when
your symptoms quickly get worse and stay worse. It is important to know what to
do if this happens. Your doctor may give you an action plan and medicines to help you breathe if you have a flare-up. But if the
attack is severe, you may need to go to the emergency room or call
911.

Managing depression and anxiety: Knowing that you have a disease that
gets worse over time can be hard. It's common to feel sad or hopeless
sometimes. Having trouble breathing can also make you feel very anxious. If
these feelings last, be sure to tell your doctor. Counseling, medicine, and
support groups can help you cope.

Health Tools

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Cause

COPD is most
often caused by smoking. Most people with COPD are long-term smokers, and
research shows that smoking cigarettes increases the risk of getting
COPD:2

Some studies show that up to
half of long-term smokers older than age 60 get COPD.3

Smoking both tobacco and marijuana increases the risk of COPD more than smoking either one.1

COPD is often a mix of two
diseases:
chronic bronchitis and
emphysema. Both of these diseases are caused by
smoking. Although you can have either chronic bronchitis or emphysema, people
more often have a mixture of both diseases.

Other causes

Other possible causes of COPD
include:

Long-term exposure to lung irritants such as industrial dust
and chemical fumes.

Inherited factors (genes),
including
alpha-1 antitrypsin deficiency. This is a rare condition in
which your body may not be able to make enough of a protein (alpha-1 antitrypsin) that
helps protect the lungs from damage. People who have this disorder and who smoke
generally start to have symptoms of emphysema in their 30s or 40s. Those who
have this disorder but don't smoke generally start to have symptoms in their
80s.

Symptoms

COPD exacerbation

Many people with COPD have attacks called
flare-ups or
exacerbations (say
"egg-ZASS-er-BAY-shuns"). This is when your usual symptoms
quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may
have to go to the hospital.

Work with
your doctor to make a plan for
dealing with a COPD flare-up. If you are prepared, you
may be able to get it under control. Try not to panic if you start to have a flare-up.
Quick treatment at home may help you manage serious breathing problems.

What Increases Your Risk

Tobacco smoking

Tobacco smoking is the most important risk factor for COPD. Compared to smoking,
other risks are minor.

Some studies show that up to
half of long-term smokers older than age 60 get COPD.3

Pipe and cigar smokers have less risk of getting COPD than
cigarette smokers. But they still have more risk than nonsmokers.

Smoking both tobacco and marijuana increases the risk of COPD more than smoking either one.1

The risk for COPD increases with both the amount of tobacco you
smoke each day and the number of years you have smoked.

Other risks

Family history

Some
people may be more at risk than others for getting the disease, especially if
they have low levels of the protein alpha-1 antitrypsin (alpha-1 antitrypsin deficiency), a disorder that runs in families.

Preterm birth

Preterm babies usually need to have long-term oxygen therapy because their lungs are not fully developed. This therapy can cause lung damage (neonatal chronic lung disease) that can increase the risk for COPD later in life.

Asthma

Asthma and COPD are different diseases, even though both of them involve breathing problems. People with asthma may have a greater risk for getting COPD, but the reasons for this are not fully understood.

Risks in the environment

Outside air pollution. Air pollution may
make COPD worse. It may increase the risk of a flare-up, or
COPD exacerbation, when your symptoms quickly get
worse and stay worse. Try not to be outside when air pollution levels are high.

Indoor air pollution. Have good
ventilation in your home to avoid indoor air pollution.

Secondhand smoke. It is not yet known whether secondhand smoke
can lead to COPD. But a large study showed that children who were exposed to secondhand smoke were more likely to get emphysema than children who weren't exposed.4 And people who are exposed to secondhand smoke for a long
time are more likely to have breathing problems and respiratory
diseases.

Occupational hazards. If your work exposes
you to chemical fumes or dust, use safety equipment to reduce the amount of
fumes and dust you breathe.

Call your doctor immediately or go
to the emergency room if you have been diagnosed with
COPD and you:

Cough up
0.5 cup (120 mL) or more of
blood.

Have shortness of breath or wheezing that is quickly getting
worse.

Start having new chest pain.

Are coughing more deeply or more often, especially if you notice
an increase in mucus (sputum) or a change in the color of the
mucus you cough up.

Have increased swelling in your legs or belly.

Have a high fever [over
101°F (38.3°C)].

Develop flu-like symptoms.

If your symptoms (cough, mucus, and/or shortness of breath)
suddenly get worse and stay worse, you may be having a
COPD flare-up, or exacerbation. Quick treatment for a
flare-up may help keep you out of the hospital.

Call your doctor soon for an appointment if:

Your medicine is not working as well as it had been.

Your symptoms are slowly getting worse, and you have not seen a
doctor recently.

You have a cold and:

Your fever lasts longer than 2 to 3 days.

Breathlessness occurs or becomes noticeably worse.

Your cough gets worse.

You have not been diagnosed with COPD but are having symptoms. A
history of smoking (even in the past) greatly increases the likelihood that
symptoms are from COPD.

You cough up any amount of blood.

Talk to your doctor

If
you have been diagnosed with COPD, talk with your doctor at your next regular
appointment about:

Help to stop smoking. To review tips on how to stop smoking, see
the topic
Quitting Smoking.

Regular checkups

Tell your doctor about any changes in
your symptoms and whether you have had any
flare-ups. Your doctor may change your medicines based
on your symptoms.

Early detection

The sooner COPD is diagnosed, the
sooner you can take steps to slow down the disease and keep your quality of
life for as long as possible. Screening tests help your doctor diagnose COPD
early, before you have any symptoms.

Talk to your doctor about
COPD screening if you:

Are a smoker or an ex-smoker.

Have had
serious asthma symptoms for a long time, and they have not improved with treatment.

The U.S. Preventive Services Task Force (USPSTF) doesn't recommend COPD screening for adults who are not at high risk for COPD.5 And some experts recommend that screening be done only for people who have symptoms of a lung problem.6

Treatment Overview

The goals of
treatment for COPD are to:

Slow down the disease by quitting smoking and avoiding triggers, such as air pollution.

Limit your symptoms, such as shortness of
breath, with medicines.

Increase your overall health with regular activity.

Prevent and treat flare-ups with medicines and other treatment.

Pulmonary rehabilitation (rehab) can help you meet these goals. It helps train your mind, muscles, and heart to get the most out of
damaged lungs. The program involves a team of health professionals who help prevent or manage the problems caused by
COPD. Rehab typically combines exercise, breathing therapy, advice for eating well, and other education.

Self-care

Much of the treatment for COPD includes things you can do for yourself.

Quitting smoking is the most important thing you can do to slow the disease and improve your quality of life.

Other things you can do that really make a difference including eating well, staying active, and avoiding triggers. To learn more, see Living With COPD.

Medicines

The medicines used to treat COPD can be long-acting to help prevent symptoms or short-acting to help relieve
them. To learn more, see Medications.

Other treatment you may need

If COPD gets worse, you may need other treatment, such as:

Oxygen treatment. This involves getting extra oxygen through a face mask or through a small tube that fits just inside your nose. It can be done in the hospital or at home.

Treatment for muscle weakness and weight loss. Many people with
severe COPD have trouble keeping their weight up and their bodies strong. This
can be treated by paying attention to eating regularly and well.

Help with depression. COPD can affect more than your lungs. It
can cause stress, anxiety, and depression. These things take energy and can
make your COPD symptoms worse. But they can be treated. If you feel very sad or anxious, call your
doctor.

Surgery. Surgery is rarely used for COPD. It's only considered for people who have severe COPD that has not improved with other treatment.

Dealing with flare-ups

COPD flare-ups, or exacerbations, are
when your symptoms—shortness of breath, cough, and mucus production—quickly get
worse and stay worse.

Work with your doctor to make a plan for
dealing with a COPD flare-up. If you are prepared, you
may be able to get it under control. Don't panic if you start to have one.
Quick treatment at home may help you prevent serious breathing problems.

A flare-up can be life-threatening, and you may need to go to your
doctor's office or to a hospital. Treatment for flare-ups includes:

Quick-relief medicines to help you breathe.

Anticholinergics
(such as ipratropium or tiotropium)

Oral corticosteroids
(such as methylprednisolone or prednisone)

Beta2-agonists (such as albuterol or
metaproterenol)

Machines to help you breathe. The use of
a machine to help with breathing is called
mechanical ventilation. Ventilation is used only if
medicine isn't helping you and your breathing is getting very difficult.

With invasive ventilation, a breathing tube
is inserted into your windpipe, and a machine forces air into your lungs.

Oxygen to help you breathe. Oxygen treatment can be done in the hospital or at home.

Antibiotics. These
medicines are used when a bacterial
lung infection is considered likely. People with
COPD have a higher risk of pneumonia and frequent lung
infections. These infections often lead to
COPD exacerbations, or flare-ups, so it's important to
try to avoid them.

Prevention

Don't smoke

The best way to keep
COPD from starting or from getting worse is to not
smoke.

There are clear benefits to quitting, even after years of
smoking. When you stop smoking, you slow down the damage to your lungs. For
most people who quit, loss of lung function is slowed to the same rate as a
nonsmoker's.

Stopping smoking is
especially important if you have low levels of the protein
alpha-1 antitrypsin. People who have an alpha-1 antitrypsin deficiency may lower their risk for severe COPD if they get regular shots of alpha-1 antitrypsin. Family members of someone with alpha-1 antitrypsin deficiency should be tested for the condition.

Avoid bad air

Other airway irritants (such as air pollution, chemical fumes, and
dust) also can make COPD worse, but they are far less important than smoking in
causing the disease.

Get vaccines

Flu vaccines

If you have COPD, you need to get a
flu vaccine every year. When people with COPD get the
flu, it often turns into something more serious, like
pneumonia. A flu vaccine can help prevent this from
happening.

Pneumococcal vaccine

People with COPD often get
pneumonia. Getting a shot can help keep you from getting very ill with
pneumonia. Usually, people need only one shot, but doctors sometimes recommend
a second shot for some people who got their first shot before they turned 65.
Talk with your doctor about whether you need a second shot.

Pertussis vaccine

Pertussis (also called whooping cough) can increase the risk of having a COPD flare-up.8 So making sure you are current on your pertussis vaccinations may help control COPD.

Ongoing Concerns

COPD gradually
gets worse over time.

Shortness of breath gets worse as COPD gets
worse.

If you are diagnosed early, before you have a lot of lung damage,
you may have very mild symptoms, even when you are active.

If you are diagnosed later, you may have already lost much of
your lung function.

If you are active, you may be short of breath during activities that didn't used to cause this problem.

If you are not very active, you may not notice how much
shortness of breath you have until your COPD gets worse.

If you have had COPD for many years, you may be short of breath
even when you are at rest. Even simple activities may cause very bad shortness of
breath.

It's very important to stop smoking. If you keep smoking after being diagnosed with COPD,
the disease will get worse faster, your symptoms will be worse, and you will
have a greater risk of having other serious health problems.

The
lung damage that causes symptoms of COPD doesn't heal
and cannot be repaired. But if you have mild to moderate COPD and you stop
smoking, you can slow the rate at which breathing becomes more difficult. You
will never be able to breathe as well as you would have if you had never
smoked, but you may be able to postpone or avoid more serious problems with
breathing.

A collapsed lung (pneumothorax).
COPD can damage the lung's structure and allow air to leak into the chest
cavity.

Sleep problems because you are not
getting enough oxygen into your lungs.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

Treatment for COPD is
getting better and better at helping people live longer. But COPD is a disease
that keeps getting worse, and it can be fatal.

A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

Living With COPD

Quit smoking

It's never too late to quit smoking. No matter how long you have had COPD or how serious it is,
quitting smoking will help slow down the disease and improve your quality of
life.

Although lung damage that already has
occurred doesn't reverse, quitting smoking can slow down how quickly your COPD
symptoms get worse.

One Man's Story:

Ned, 56

"I tried to quit cold turkey, but after just a few days
I could tell that wasn't going to work. I realized that I needed to try
something else. So I tried the patch, and that made a big difference. I can
feel a difference in my breathing. And I feel hopeful that quitting will give
me a few more years on my feet."—Ned

You may think that nothing can help you quit. But today
there are several treatments shown to be very good at helping people stop
smoking. They include:

Nicotine replacement therapy.

The medicines
bupropion (Wellbutrin or Zyban) and
varenicline (Chantix).

Support
groups.

Today's medicines offer lots of help for people who want to quit. You
will double your chances of quitting even if medicine is
the only treatment you use to quit, but your odds get even better when you
combine medicine and other quit strategies, such as counseling.9

Conserve your energy. You may get more tasks done and feel better if you learn to save energy while doing chores and other activities. Take rest breaks and sit down whenever you can while you fold laundry, cook, and do other household tasks. An occupational or
physical therapist can help you find ways to do everyday activities with less
effort.

Stay as active as possible, and get
regular exercise. Try to do activities and exercises that build muscle strength
and help your
cardiovascular system. If you get out of breath, wait until your breathing returns to normal before continuing.

Eat well

Good nutrition is important to keep up
your strength and health. Problems with
muscle weakness and weight loss are common in people
with severe COPD. It's dangerous to become very underweight. It may affect how long you are expected to live.10

Seek education and support

Treating more than the
disease and its symptoms is very important. You also need:

Education. Educating yourself and your
family about COPD and your treatment program helps you and your family cope
with your lung disease.

Counseling and support. Shortness of
breath may reduce your activity level and make you feel socially isolated
because you cannot enjoy activities with your family and friends. You should be
able to lead a full life and be
sexually active. Counseling and support groups can
help you learn to live with COPD.

A support network of family, friends,
and health professionals. Learning that you have a disease that may shorten
your life can trigger
depression or grieving. Anxiety can make your symptoms
worse and can trigger flare-ups or make them last longer. Support from family
and friends can reduce anxiety and stress and make it easier to live with
COPD.

Your treatment plan. Following a
treatment plan will make you feel better and less likely to become depressed. A
self-reward system—such as a night out to eat after staying on your medicine
and exercise schedule for a week—can help keep you motivated.

One Woman's Story:

Sarah, 67

"Not being the person I used to be—it makes me really
sad sometimes. There are lots of days I don't want to even get up, but then I
think about taking my walk or seeing my friends, and I want get out there. COPD
may slow me down, but it isn't going to stop me."—Sarah

Medications

Prevent
COPD flare-ups, also called exacerbations, or keep the
flare-ups you do have from being life-threatening.

Most people with COPD find that medicines make breathing
easier.

Some COPD medicines are used with devices called
inhalers or
nebulizers. It's important to learn how to
use these devices correctly. Many people don't, so they don't get the full
benefit from the medicine.

Medicine choices

Short-acting bronchodilators ease
your symptoms. They are considered a good first choice for treating stable COPD
in a person whose symptoms come and go (intermittent symptoms). They include:

Anticholinergics (such as
ipratropium).

Beta2-agonists (such as albuterol or
levalbuterol).

A combination of the two (such as a combination of albuterol and ipratropium).

Long-acting bronchodilators help
prevent breathing problems. They help people whose symptoms do not go away
(persistent symptoms). They include:

Anticholinergics (such as aclidinium or tiotropium).

Beta2-agonists (such as arformoterol, formoterol, or
salmeterol).

A combination of the two, or a combination of a beta2-agonist and a corticosteroid medicine.

Phosphodiesterase-4 (PDE4) inhibitors are taken every day to help prevent COPD exacerbations. The only PDE4 inhibitor available is roflumilast (Daliresp).

Corticosteroids
(such as prednisone) may be used in pill form to treat a
COPD flare-up or in an inhaled form to prevent
flare-ups. They are often used if you also have
asthma.

Other medicines include methylxanthines, which
generally are used for severe cases of COPD. They may have serious side
effects, so they are not usually recommended.

Tips for using inhalers

The first time you use a bronchodilator, you
may not notice much improvement in your symptoms. This doesn't always mean
that the medicine won't help. Try the medicine for a while before you decide
if it is working.

Many people don't use their inhalers right, so they don't get
the right amount of medicine. Ask your health care provider to show you what to do.
Read the instructions on the package carefully.

Most doctors recommend using
spacers with metered-dose inhalers. But you should not use a spacer with a dry
powder inhaler.

Surgery

Lung surgery is rarely used to treat
COPD. Surgery is never the first treatment choice and
is only considered for people who have severe COPD that has not improved with
other treatment.

Surgery choices

Lung volume reduction surgery removes part of one or both lungs, making
room for the rest of the lung to work better. It is used only for some types of severe
emphysema.

Lung transplant replaces a sick lung with a healthy lung
from a person who has just died.

Bullectomy removes the part of the lung that has been
damaged by the formation of large, air-filled sacs called bullae. This surgery
is rarely done.

Other Treatment

Other treatment for
COPD includes:

Oxygen treatment. This treatment
involves breathing extra oxygen through a face mask or through a tube inserted
just inside your nose. It may ease shortness of breath. And it can help people
with very bad COPD and low oxygen levels live longer.

Qaseem A, et al. (2011). Diagnosis and management of stable chronic obstructive pulmonary
disease: A clinical practice guideline update from the American
College of Physicians, American College of Chest Physicians,
American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine, 155(3): 179–191.

Qaseem A, et al. (2011). Diagnosis and management of stable chronic obstructive pulmonary
disease: A clinical practice guideline update from the American
College of Physicians, American College of Chest Physicians,
American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine, 155(3): 179–191.

Qaseem A, et al. (2011). Diagnosis and management of stable chronic obstructive pulmonary
disease: A clinical practice guideline update from the American
College of Physicians, American College of Chest Physicians,
American Thoracic Society, and European Respiratory Society. Annals of Internal Medicine, 155(3): 179–191.

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